H.R. 1860, Women Veterans Cancer Care Coordination Act

Bill Summary

H.R. 1860 would require the Department of Veterans Affairs (VA) to designate care coordinators for veterans with breast or gynecologic cancer. The bill also would extend a temporary limitation on certain pension payments through September 2032.

Estimated Federal Cost

The estimated budgetary effects of H.R. 1860 are shown in Table 1. The costs of the legislation fall within budget functions 550 (health) and 700 (veterans benefits and services).

Basis of Estimate

For this estimate, CBO assumes that H.R. 1860 will be enacted in fiscal year 2025 and that outlays will follow historical spending patterns for similar VA programs.

Provisions that Affect Spending Subject to Appropriation and Direct Spending

Section 2 would require VA to designate or hire a care coordinator for breast and gynecologic cancer in each of the department’s 18 Veterans Integrated Services Networks (VISN) within one year of enactment. The coordinators would monitor and integrate care for those cancers that veterans receive from the department directly and through the VA-funded Community Care program. The coordinators also would collect and report information on the outcomes of veterans’ cancer treatment.

Under section 2, VA would need one full-time employee in each VISN. CBO estimates that annual compensation and operating expenses would amount to $215,000 per person, on average. Implementing section 2 would therefore cost $38 million over the 2025-2035 period.

CBO expects that some of the costs of implementing the bill would be paid from the Toxic Exposures Fund (TEF) established by Public Law 117-168, the Honoring our PACT Act. The TEF is a mandatory appropriation that VA uses to pay for health care, disability claims processing, medical research, and IT modernization that benefit veterans who were exposed to environmental hazards.

Additional spending from the TEF would occur if legislation increases the costs of similar activities that benefit veterans with such exposure. Thus, in addition to increasing spending subject to appropriation, enacting section 2 would increase amounts paid from the TEF, which are classified as direct spending. CBO projects that the proportion of costs paid by the TEF will grow over time based on the amount of formerly discretionary appropriations that CBO expects will be provided through the mandatory appropriation as specified in the Honoring our PACT Act.[1]

CBO estimates that over the 2025-2035 period, implementing section 2 would increase spending subject to appropriation by $28 million and direct spending by $10 million.

Direct Spending

In addition to expanding benefits that would partly be covered by the TEF, enacting H.R. 1860 would affect direct spending by extending a statutory limitation on VA pension payments. In total, enacting the bill would decrease net direct spending by $30 million over the 2025-2035 period (see Table 2).

Under current law, VA reduces pension payments to veterans and survivors who reside in Medicaid nursing homes to $90 per month. That required reduction expires November 30, 2031. Section 3 would extend that reduction for 10 months, through September 30, 2032. CBO estimates that extending that requirement would reduce VA benefits by $10 million per month. (Those benefits are paid from mandatory appropriations and are therefore considered direct spending.) As a result of that reduction in beneficiaries’ income, Medicaid would pay more of the cost of their care, increasing spending for that program by $6 million per month. Thus, enacting section 3 would reduce net direct spending by $40 million over the 2025-2035 period.

Spending Subject to Appropriation

The discussion above in “Provisions That Affect Spending Subject to Appropriation and Direct Spending” describes the costs of implementing the care coordination program for veterans with breast or gynecologic cancer. CBO estimates that establishing the program would increase spending subject to appropriation by $28 million over the 2025‑2035 period.

Section 2 also would require VA to submit a report comparing health outcomes of veterans who receive care for breast and gynecologic cancer through VA facilities and community care providers. Based on the costs of similar reporting requirements, CBO estimates that preparing the report would cost less than $500,000 over the 2025‑2035 period. Any such spending would be subject to the availability of appropriated funds.

Pay-As-You-Go Considerations

The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. The net changes in outlays that are subject to those pay-as-you-go procedures are shown in Table 1.

Increase in Long-Term Net Direct Spending and Deficits

CBO estimates that enacting H.R. 1860 would not increase net direct spending by more than $2.5 billion in any of the four consecutive 10-year periods beginning in 2036.

CBO estimates that enacting H.R. 1860 would not increase on‑budget deficits by more than $5 billion in any of the four consecutive 10-year periods beginning in 2036.

Mandates

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.

Federal Costs:

Noah Callahan (for veterans’ health care) 
Logan Smith (for veterans’ and survivors’ pensions)

Mandates: Grace Watson

Estimate Reviewed By

David Newman
Chief, Defense, International Affairs, and Veterans’ Affairs Cost Estimates Unit

Kathleen FitzGerald 
Chief, Public and Private Mandates Unit

Christina Hawley Anthony
Deputy Director of Budget Analysis